Provider Demographics
NPI:1306402326
Name:ASHEBORO FAMILY COUNSELING, PLLC
Entity Type:Organization
Organization Name:ASHEBORO FAMILY COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:SAYERS
Authorized Official - Last Name:CHAMBERS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:336-625-3888
Mailing Address - Street 1:292 WALNUT DR
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27205-9484
Mailing Address - Country:US
Mailing Address - Phone:336-629-4255
Mailing Address - Fax:
Practice Address - Street 1:505 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-5673
Practice Address - Country:US
Practice Address - Phone:336-625-3888
Practice Address - Fax:336-625-6113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-15
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6009284Medicaid